This invention relates generally to a medical communication system; and, more particular, to a system and method for enabling a remotely-located clinician to participate in, and provide advice, during a surgical medical being performed at a different location.
Many medical procedures such as the implantation of medical devices require the cooperation and coordination of various surgical and other medical skills. While the necessary surgical skills are filled by surgeons or other physicians, the need for other technical expertise usually necessitates the presence of a field representative or other technical personnel.
While some prior art medical communications systems have been provided to facilitate the cooperation of multiple medical experts located at different locations, these solutions are not particularly well suited to the surgical or clinical environments. One example of a communication system for use in medical applications is the model 89441a Vector Signal Analyzer((trademark)) from Hewlett Packard. This system allows a remote expert to control screen data being displayed on a workstation located at the site of the medical procedure. However, this system does not allow the remotely-located expert to view real-time physiological data and/or video data captured during the procedure. Moreover, this system does not allow screen data replicated at both local and remote sites to be interactively manipulated, as by use of a pointer, at either of the locations.
Other prior art communications systems are described in the following U.S. patents:
U.S. Pat. No. 5,241,625, issued to Epard et al. discloses a system for remotely observing and optionally controlling information, including text and graphical images that are displayed on a computer from among both homogeneous and heterogeneous computers coupled in a network or via other transport media such as magnetic disks captures window system event messages during a recording process. Such messages are then translated into procedure calls during the imaging process on the destination platform.
U.S. Pat. No. 5,384,643, issued to Inga et al. discloses a storage, retrieval, and transmission system that is configured to provide fast, efficient telecommunication access to digitized images (e.g., medical diagnostic X-ray images) to multiple requesting subscribers. Image data are downloaded, via the telephone lines, to a remote display terminal in an optimal fashion that employs a two-dimensional patterned data compression scheme. The data compression methods include a xe2x80x9cHex-Pacxe2x80x9d compression in which one first generates regions comprising a plurality of two dimensional, non-overlapping, symmetrically disposed super pixels that are collectively representative of an image. Each of these regions is subsequently compared with a plurality of fictitious patterns, each of which has a dark region, a light region and a predetermined point of origin, in order to determine which of the patterns most closely correlates with the selected region.
U.S. Pat. No. 4,377,852, issued to Thompson discloses a communications control system for enabling a small computer system, such as a personal computer, to emulate a terminal and thus to communicate with a remote system. Incoming data from the remote system is entered into a circular buffer on an interrupt basis. The communications control system alternately scans the circular buffer for newly entered data and the keyboard for operator generated messages. Any control characters are decoded and appropriate actions taken. Received alphanumeric characters are stored in a display memory for video display and in a system RAM for later retrieval and study.
U.S. Pat. No. 5,263,869, issued to Ziv-El, which discloses a computerized teaching system is described, which comprises an interactive group communication system, wherein students in a first group interact with a teacher in Social Mode, and, in some case, while students in a second group proceed with work in Independent Mode.
U.S. Pat. No. 5,452,299, issued to Thessin et al. discloses a method and apparatus for communication between agents in an electronic conferencing system. In an electronic conferencing system wherein data is shared between a plurality of participants during an electronic conference, a method is disclosed for transferring large object data blocks among the participants during the electronic conference comprising the following steps: a) receiving an asynchronous request for large object data; b) placing the request in a request queue; c) receiving an asynchronous request for reprioritization of the request queue; d) determining a transport medium capability; e) partitioning the large object data into data blocks, a size of the data blocks being variable and corresponding to the capability of the transport medium; f) transferring the requested large object data to each of the participants via the transport medium; and g) removing the request from the request queue upon completion of the step of sending the requested large object data.
U.S. Pat. No. 5,168,269, issued to Harlan discloses a system which has a first computer (herein termed the SUPPORT PC) and second remotely located computer (herein termed the CUSTOMER PC). The SUPPORT PC and the CUSTOMER PC each have a display. The image displayed on the CUSTOMER PC""s display is transmitted to and duplicated on the SUPPORT PC""s display. The SUPPORT PC is equipped with an analog input device (such as a mouse), the efficient operation of which requires immediate visual feedback. Signals from the input device are transmitted to the remote CUSTOMER PC. The images which appear on the display of the remote CUSTOMER PC are transmitted, relatively slowly, to the display of the SUPPORT PC. In order to provide immediate visual feedback to the operator of the input device at the SUPPORT PC, a Dynamic Temporary Dual Cursor is shown on the screen of the SUPPORT PC along with the regular cursor which is transmitted from the CUSTOMER PC. The Dynamic Temporary Dual Cursor is moved in quick synchronization with movement of the input device in direct response to the input device.
U.S. Pat. No. 4,317,956 issued to Torok et al. discloses a telautograph system that allows a user at one location to write on a special surface, such as a chalkboard, and have the image appear at remote screens. Presently, a user wishing to call attention to an entry already written on the board must make a new line or must circle the item to which the remote viewer""s attention is to be drawn. This procedure unduly clutters the image and a system has been devised which provides for a cursor (a graphical hand) to appear on the remote screen when the user touches the input surface at a point. The cursor also appears when the user is writing on the surface so as to call attention to the newly formed images.
U.S. Pat. No. 4,098,267, issued to Stein et al. discloses a system for displaying several lines of electrocardiographic (ECG) signals on a cathode ray tube screen for observation, analysis and selection of those portions of the signals which indicate abnormalities of heart rhythm and cardiac events of interest to the diagnostician or trained observer. The ECG signals may be recorded at real time but are inputted to the system at much greater than real time. The system provides the display of the signal portions which were recorded consecutively, each on a separate vertically displayed line. Together with the ECG signals, other alphanumeric data, such as the time of day when the signals were recorded, patient name, heart rate, cardiac condition, and other pertinent information, may also be displayed simultaneously with the lines of ECG signals by the use of the memory and storage means to receive and hold such data. As consecutive sets of lines of the ECG signals are presented for display, sections of each line containing abnormalities and cardiac events of interest may be identified by an observer and transferred through the memory to the storage unit.
U.S. Pat. No. 5,235,680, issued to Bijnagte, discloses a system and method for storing, retrieving displaying, printing and otherwise manipulating color images stored in a central xe2x80x9chostxe2x80x9d computer from a realtor""s remote data terminal includes a host computer which stores and maintains a database containing listings of real estate properties on the market. The host computer also optionally can store image information relating to specific properties. Images can be loaded from remote terminals over telephone lines to the host system on an interactive basis. Images can then be retrieved from the host system, also on an interactive basis, for display, printing, or storage on a storage medium associated with the remote display terminals. Images may also be deleted on an interactive basis from a remote terminal.
What is needed, therefore, is an improved communications system for displaying in real-time, or near real-time, physiological signal data at multiple locations. This signal data includes the position of a pointer that may be manipulated at multiple locations so that communication is facilitated between the various experts discussing and viewing the data, and further includes video data obtained from the patient site.
The current invention provides a system for allowing medical data obtained at a first (local) site to be transferred to a second, remote site. This medical data may include video data and/or data obtained from one or more medical devices such as a fluoroscopy device or an electrocardiograph (ECG) signal monitor.
The inventive system includes a communications network located at a first site such as a clinic or hospital where a medical procedure or a patient examination is being conducted. This communications network may be coupled to a video device such as a camera adapted to obtain video-formatted data of the procedure. The video device may be adapted to also provide an audio signal. Video data obtained at the first site may be transferred over the communications network to the remote site. At the remote site, a data processing system such as a personal computer or a programmer for programming an implantable medical device (IMD) is executing software that allows the video data to be received and viewed on a display screen. In one embodiment of the invention, the data processing system displays the video data in substantially real-time. In this manner, a remotely-located expert is allowed to view a procedure occurring at the first location.
As discussed above, many types of data may be transferred to the remote data processing system. In one embodiment, an x-ray fluoroscopy device is used to obtain an image of fluoro-visible media that is located within a patient""s body. This image may be transferred to the remote system for viewing on the display screen of the data processing system. In another embodiment, an ECG signal may be obtained from a device intercoupled to the patient via electrodes located on the patient""s body. This ECG signal may be transferred via the communications network to be viewed on the remote system.
Yet another type of device that may be coupled to the communications network is a programmer of the type used to program IMDs. Programmers may be used to both display patient data retrieved from an IMD including an electrodcardiogram (EGM) of a patient""s heart, and to initialize and modify the configuration of the IMD. In one embodiment of the invention, screen data being displayed by a programmer located at the local site is transferred for display at the remote site. Additionally, cursor movements as controlled by a clinician at the local site are also displayed to an expert at the remote site to better facilitate communication.
According to another aspect of the invention, a remote expert is allowed to control cursor movements and to modify screen data. Any changes made by the remote expert to one or more display windows of the data processing system may be transferred via the communications network to be mirrored on a corresponding display of the programmer at the local site. In one embodiment, an audio signal obtained from the remote site may also be transferred to the local site. In this manner, the remote expert is better able to participate in the procedure or examination being conducted at the local site.
In one embodiment of the invention, the amount of screen data transferred between the local and remote sites is minimized by only transmitting data associated with screen updates. Portions of a screen display that are not modified are refreshed using previously-transferred data. Data encoding schemes may be employed to further reduce the size of the transfers.
Routing of the data between the local and remote sites may be performed by a hub. In one embodiment, the hub is a stand-alone unit coupling the medical, video, audio, and programming devices to the communications network. The hub implements one or more communication stacks to facilitate the routing of this information to the remote site, and routing of data from the remote site to the programmer.
In an alternative embodiment of the invention, the programmer performs data routing functions associated with the current invention. In this embodiment, the programmer is coupled directly to video, audio, and other medical devices to receive, temporarily buffer, and re-transmit the data to the communications network for transfer to the remote site.